Grading Using Ki-67 Index and Mitotic Rate Increases the Prognostic Accuracy of Pancreatic Neuroendocrine Tumors

Prejesh Philips, David A. Kooby, Shishir Maithel, Nipun Merchant, Sharon M. Weber, Emily R. Winslow, Syed Ahmad, Hong J. Kim, Charles R. Scoggins, Kelly M. McMasters, Robert C.G. Martin

Research output: Contribution to journalArticle

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Abstract

Objectives To measure the usefulness of Ki-67 proliferative index (Ki-67 index) as a prognostic variable for grading pancreatic neuroendocrine tumors. Methods A multi-institutional prospective database comprising 350 patients. Grading based on mitotic activity (<2 mitoses/10 high-power fields, 2-20 and >20) and Ki-67 index (<3% per 10 high-power fields, 3%-20% and >20%). Final grade selected based on higher grade of either variable. Results Most patients were in the less than 3% (n = 158) and 3% to 20% Ki-67 category (n = 107), with a minority being high-grade (Ki-67 > 20%, n = 27). Discordance between Ki-67 and mitotic rate was noted in 58 patients. On multivariate analysis, final-grade (grade 2: P = 0.010, hazard ratio [HR], 1.2; grade 3: P = 0.002; HR, 2.8), Ki-67, mitotic rate, and lymph node status were significant prognostic markers for overall survival (OS). For disease-free survival (DFS), only final-grade (grade 2: P = 0.05; HR, 1.4; grade 3: P = 0.009; HR, 2.3), Ki-67, mitotic rate, and margin status significantly predicted DFS. Ki-67 was a better model for OS and mitotic rate for DFS. Overall combined final grade was the best model based on HR. Conclusion Ki-67 is a strong prognostic factor for OS and DFS and should be included in all pancreatic neuroendocrine tumor pathology.

Original languageEnglish (US)
Pages (from-to)326-331
Number of pages6
JournalPancreas
Volume47
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Mitotic Index
Neuroendocrine Tumors
Disease-Free Survival
Survival
Multivariate Analysis
Survival Rate
Lymph Nodes
Databases
Pathology

Keywords

  • Ki-67 proliferative index
  • Mitotic rate
  • Neuroendocrine tumors
  • Pancreas
  • Prognostic factors

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Philips, P., Kooby, D. A., Maithel, S., Merchant, N., Weber, S. M., Winslow, E. R., ... Martin, R. C. G. (2018). Grading Using Ki-67 Index and Mitotic Rate Increases the Prognostic Accuracy of Pancreatic Neuroendocrine Tumors. Pancreas, 47(3), 326-331. https://doi.org/10.1097/MPA.0000000000000990

Grading Using Ki-67 Index and Mitotic Rate Increases the Prognostic Accuracy of Pancreatic Neuroendocrine Tumors. / Philips, Prejesh; Kooby, David A.; Maithel, Shishir; Merchant, Nipun; Weber, Sharon M.; Winslow, Emily R.; Ahmad, Syed; Kim, Hong J.; Scoggins, Charles R.; McMasters, Kelly M.; Martin, Robert C.G.

In: Pancreas, Vol. 47, No. 3, 01.03.2018, p. 326-331.

Research output: Contribution to journalArticle

Philips, P, Kooby, DA, Maithel, S, Merchant, N, Weber, SM, Winslow, ER, Ahmad, S, Kim, HJ, Scoggins, CR, McMasters, KM & Martin, RCG 2018, 'Grading Using Ki-67 Index and Mitotic Rate Increases the Prognostic Accuracy of Pancreatic Neuroendocrine Tumors', Pancreas, vol. 47, no. 3, pp. 326-331. https://doi.org/10.1097/MPA.0000000000000990
Philips, Prejesh ; Kooby, David A. ; Maithel, Shishir ; Merchant, Nipun ; Weber, Sharon M. ; Winslow, Emily R. ; Ahmad, Syed ; Kim, Hong J. ; Scoggins, Charles R. ; McMasters, Kelly M. ; Martin, Robert C.G. / Grading Using Ki-67 Index and Mitotic Rate Increases the Prognostic Accuracy of Pancreatic Neuroendocrine Tumors. In: Pancreas. 2018 ; Vol. 47, No. 3. pp. 326-331.
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abstract = "Objectives To measure the usefulness of Ki-67 proliferative index (Ki-67 index) as a prognostic variable for grading pancreatic neuroendocrine tumors. Methods A multi-institutional prospective database comprising 350 patients. Grading based on mitotic activity (<2 mitoses/10 high-power fields, 2-20 and >20) and Ki-67 index (<3{\%} per 10 high-power fields, 3{\%}-20{\%} and >20{\%}). Final grade selected based on higher grade of either variable. Results Most patients were in the less than 3{\%} (n = 158) and 3{\%} to 20{\%} Ki-67 category (n = 107), with a minority being high-grade (Ki-67 > 20{\%}, n = 27). Discordance between Ki-67 and mitotic rate was noted in 58 patients. On multivariate analysis, final-grade (grade 2: P = 0.010, hazard ratio [HR], 1.2; grade 3: P = 0.002; HR, 2.8), Ki-67, mitotic rate, and lymph node status were significant prognostic markers for overall survival (OS). For disease-free survival (DFS), only final-grade (grade 2: P = 0.05; HR, 1.4; grade 3: P = 0.009; HR, 2.3), Ki-67, mitotic rate, and margin status significantly predicted DFS. Ki-67 was a better model for OS and mitotic rate for DFS. Overall combined final grade was the best model based on HR. Conclusion Ki-67 is a strong prognostic factor for OS and DFS and should be included in all pancreatic neuroendocrine tumor pathology.",
keywords = "Ki-67 proliferative index, Mitotic rate, Neuroendocrine tumors, Pancreas, Prognostic factors",
author = "Prejesh Philips and Kooby, {David A.} and Shishir Maithel and Nipun Merchant and Weber, {Sharon M.} and Winslow, {Emily R.} and Syed Ahmad and Kim, {Hong J.} and Scoggins, {Charles R.} and McMasters, {Kelly M.} and Martin, {Robert C.G.}",
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T1 - Grading Using Ki-67 Index and Mitotic Rate Increases the Prognostic Accuracy of Pancreatic Neuroendocrine Tumors

AU - Philips, Prejesh

AU - Kooby, David A.

AU - Maithel, Shishir

AU - Merchant, Nipun

AU - Weber, Sharon M.

AU - Winslow, Emily R.

AU - Ahmad, Syed

AU - Kim, Hong J.

AU - Scoggins, Charles R.

AU - McMasters, Kelly M.

AU - Martin, Robert C.G.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objectives To measure the usefulness of Ki-67 proliferative index (Ki-67 index) as a prognostic variable for grading pancreatic neuroendocrine tumors. Methods A multi-institutional prospective database comprising 350 patients. Grading based on mitotic activity (<2 mitoses/10 high-power fields, 2-20 and >20) and Ki-67 index (<3% per 10 high-power fields, 3%-20% and >20%). Final grade selected based on higher grade of either variable. Results Most patients were in the less than 3% (n = 158) and 3% to 20% Ki-67 category (n = 107), with a minority being high-grade (Ki-67 > 20%, n = 27). Discordance between Ki-67 and mitotic rate was noted in 58 patients. On multivariate analysis, final-grade (grade 2: P = 0.010, hazard ratio [HR], 1.2; grade 3: P = 0.002; HR, 2.8), Ki-67, mitotic rate, and lymph node status were significant prognostic markers for overall survival (OS). For disease-free survival (DFS), only final-grade (grade 2: P = 0.05; HR, 1.4; grade 3: P = 0.009; HR, 2.3), Ki-67, mitotic rate, and margin status significantly predicted DFS. Ki-67 was a better model for OS and mitotic rate for DFS. Overall combined final grade was the best model based on HR. Conclusion Ki-67 is a strong prognostic factor for OS and DFS and should be included in all pancreatic neuroendocrine tumor pathology.

AB - Objectives To measure the usefulness of Ki-67 proliferative index (Ki-67 index) as a prognostic variable for grading pancreatic neuroendocrine tumors. Methods A multi-institutional prospective database comprising 350 patients. Grading based on mitotic activity (<2 mitoses/10 high-power fields, 2-20 and >20) and Ki-67 index (<3% per 10 high-power fields, 3%-20% and >20%). Final grade selected based on higher grade of either variable. Results Most patients were in the less than 3% (n = 158) and 3% to 20% Ki-67 category (n = 107), with a minority being high-grade (Ki-67 > 20%, n = 27). Discordance between Ki-67 and mitotic rate was noted in 58 patients. On multivariate analysis, final-grade (grade 2: P = 0.010, hazard ratio [HR], 1.2; grade 3: P = 0.002; HR, 2.8), Ki-67, mitotic rate, and lymph node status were significant prognostic markers for overall survival (OS). For disease-free survival (DFS), only final-grade (grade 2: P = 0.05; HR, 1.4; grade 3: P = 0.009; HR, 2.3), Ki-67, mitotic rate, and margin status significantly predicted DFS. Ki-67 was a better model for OS and mitotic rate for DFS. Overall combined final grade was the best model based on HR. Conclusion Ki-67 is a strong prognostic factor for OS and DFS and should be included in all pancreatic neuroendocrine tumor pathology.

KW - Ki-67 proliferative index

KW - Mitotic rate

KW - Neuroendocrine tumors

KW - Pancreas

KW - Prognostic factors

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